The APTA recently posted a video titled "You Can Be Me" on their Web page at www.beapt.org. PT and PTA members of APTA who represent several physical therapy practice settings are featured in the video.

"This powerful new video and Web page provides an up-close and personal view of the physical therapy profession," said APTA president R. Scott Ward PT, PhD, in a press release. "The empowering nature of the physical therapy profession is sincerely and powerfully depicted in this video."

The video highlights the personal choices made by APTA members in their decision to become PTs and PTAs.

If you're looking for more than an 11-minute video to help solidify your plans for the future, head over to ADVANCE for PTs and PTAs student center. This section of our Website teaches current and prospective PT students all about the profession. Check it out here.

OK, it wasn't a situation where I needed rehab, I admit. I was just hanging out with friends-one of whom has his entire living room-big-screen TV, speakers, the whole works-dedicated to what you could call an in-house "studio" solely for the purpose of, well, rocking out.

For a few hours, I found myself immersed in "Rock Band," an X-Box game system that allows "players" to assume membership in a rock band either as a singer, guitarist, bass player or drummer and "virtually" play popular rock songs, in sort of a physical Karaoke.

Right away I could see why the system and others like it, including Wii sports, would provide a unique opportunity for rehabilitation. The game was not only fun and diverting, it was also work. Even after one hour I felt my coordination improving-even though I was merely pressing a color-coded button and following the direction on the screen. As I "played" my timing and anticipation of my next move got better and better and I actually got the sense that I could "play" guitar (or at least follow notes and chords) even though I had never previously picked up the actual instrument.

Following traumatic brain injury of any sort, the mind has to go through so much to relearn natural movement, timing, coordination and dexterity. In many ways, the therapy required can resemble gaming-combining specific movements together in a coordinated way to achieve a result.

Patients can actually see that they know how to complete a movement they thought they had never learned-kind of like me and the guitar. Not to mention the fun it can provide. Hitting the right notes on time and making "music" made three hours go by like one.

Are PTs and PTAs out there considering gaming a viable way to incorporate more stimulation and cooperation in patients? If you have used computerized programs for patients and have had success, let us know. It could be a technological trend that brings music to the ears of patients with brain injury in the future.

In the story, Army Sgt. Nick Paupore was traveling in a Humvee in Kirkuk City, Iraq, when a roadside bomb struck his vehicle. The blast ripped out part of Papore's leg (including an artery), and left him with less than two pints of blood. Eventually he was taken to Germany where his life was saved, but his leg was not.

Following his life-saving surgery and subsequent amputation, Paupore experienced agonizing phantom limb pain. When the pain became too much, he joined Dr. Jack Tsao's clinical trial at Walter Reed Army Medical Center to test the mirror therapy theory.

What is mirror therapy? According to the article:

The patient sits on a flat surface with his or her remaining leg straight out and then puts a 6-foot mirror lengthwise facing the limb. The patient moves the leg, flexing it, and watches the movement in the mirror. The reflection creates the illusion of two legs moving together.

The mirror tricks the brain into "seeing" the amputated leg, overriding mismatched nerve signals.

For the amputees who experience debilitating phantom limb pain, mirror therapy may be just the solution that can help them rebuild their lives.

Possible infringement by other professions is one of the most important issues facing physical therapy today. This issue has been highlighted by the recent lawsuit filed against APTA by the NATA.

The APTA Website states, "The National Athletic Trainers' Association (NATA) on February 1, 2008, filed a lawsuit against APTA and the Orthopaedic Section, APTA, Inc. in the U.S. District Court in Dallas. The complaint alleges that the APTA and the Section have violated the antitrust laws by seeking to deny athletic trainers (ATCs) access to the market for manual therapy and by coercing physical therapists to refrain from educating ATCs in certain techniques. APTA's counsel is currently reviewing the complaint. APTA believes that the NATA lawsuit is wholly without merit."

The link below details the sequence of events that has taken place, according to APTA. What are your thoughts about these developments?

A report by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders to be published in the Feb. 15 issue of the journal Spine stresses the need for a systematic, evidence-based approach to neck pain. The study can be read here.

The report names PT, exercise, manual therapy done by a chiropractor and pain medications as treatment options for neck pain, but says that there are "no important differences" between competing treatment options for nonspecific neck pain and that the choice "depends on the patient's and physician's preferences." What do you think?

Just last week actor Dennis Quaid and his wife, Kimberly, found out exactly what happened to their twin babies mere days after they were born. They have recently made headlines because they are infuriated to learn of the details surrounding the medical error months after the initial incident.

A preliminary report detailed that the Quaid's newborns were given doses of heparin (a high-risk blood thinner) 1,000 times stronger than what was prescribed. However, last Wednesday a second report showed that the children were actually given two vials containing 10,000 units per milliliter of heparin--or 2,000 times stronger than what was prescribed.

How the hospital tackled the issue of medical errors was regrettably left off the front page--and that's something that shouldn't be ignored. In this case, the hospital took steps to review all policies and procedures involving high-risk medication and provided more training to its staff.

Unfortunately medical errors happen too often. So, to help health care providers reduce mistakes, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) designed 17 free, publicly available toolkits that can be adapted to most health care settings.

Released in December, the toolkits focus on an array of issues, including identifying high-risk practices and reducing medication errors or other patient harms. The following are examples of different toolkits:

• The Re-Engineered Hospital Discharge "Project RED" toolkit.
• The Medications at Transitions and Clinical Handoffs "MATCH" toolkit.
• The Preventing Venous Thromboembolisms in the Hospital and the Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients toolkits.
• The ED Pharmacist as a Safety Measure in Emergency Medicine toolkit.

For more information and a complete listing of the 17 toolkits, visit http://www.ahrq.gov/qual/pips.

Last June at the APTA Annual Conference, representatives from the government affairs section gave their annual overview of legislative issues directly affecting the PT profession. The session evolved into sort of a "wish list" of priorities that the profession's leaders wanted to see resolved by the end of 2007.

These included legislation on the physician fee schedule and avoiding a projected increase of almost 10 percent, an extension of the physician quality reporting initiative (PQRI) as it stood, and-failing a repeal of the $1,780 Medicare cap on outpatient therapy entirely-an extension of the therapy cap exceptions process.

In the last few weeks of 2007, the APTA got what it wished for-sort of. The 2008 Final Physician Fee Schedule rule was issued on Nov. 1, 2007. But for the next month and a half, there was little Congressional movement on any of the Medicare measures until a bill was proposed in the Senate on Dec. 18. 2007. The Medicare, Medicaid and SCHIP Extension Act of 2007 (S. 2499) was passed and then signed by President Bush on Dec. 29, 2007.

According to the APTA (http://www.apta.org/), several key provisions were included:

Extension of the therapy cap exceptions process through June 30, 2008; the 2008 therapy cap is now set at $1,810.

An increase in the physician payment rate; extension of the PQRI. This replaces the scheduled 10.1 percent cut to the Medicare physician reimbursement rate in 2008 with a 0.5 percent increase through June 30, 2008.

Extension of the floor on work geographic adjustment. Extends the work geographic index (GPCI) floor of 1.0 through June 30, 2008.

Payments for inpatient rehabilitation facility (IRF) services. Permanently freezes the IRF services compliance threshold at 60 percent. Sets the market basket update factor at 0 percent from April 1, 2008, through FY09.

Reauthorization of SCHIP to March 2009.

Back in June, the hope from lobbyists was that the fee schedule would not see the drastic percentage cut, and that seems to have been avoided. The organization also hoped for a year-long extention on the exceptions process. The legislation most certainly helps avoid major patient care problems and cutbacks for PTs. The cap still exists-but perhaps PTs have now found innovative ways to make it work for their most needy patients.

What do you think of the measures only effective until June of this year? Do these legislative outcomes work for the profession for now? And are there still PTs out there who are optimistic that the therapy cap will be repealed someday?

A study recently cited by the APTA says that patients who begin physical therapy while still in the
ICU often reduce the length of their hospital stays.
 
The research, conducted by Peter Morris, M.D., associate professor in the Section on
Pulmonary, Critical Care, Allergy and Immunologic Diseases at Wake Forest University
Baptist Medical Center, showed that the length of stay for a group of respiratory-failure
patients who received early mobilization and PT within 48 hours of the insertion of a
breathing tube was reduced by an average of three days compared with the stay for patients
who did not receive the therapy.

In addition to tubes, many ICU patients are connected to other equipment or machines that
can make it hard to perform therapy. How do you work around this paraphernalia
when giving PT to patients in the ICU? Are there any circumstances in which you would
not want to perform PT in the ICU?

According to a recent CNN article, some people may put on five to seven pounds thanks to a steady diet of large meals, high-calorie beverages and irresistible desserts throughout the fall and winter. However, according to government surveys, the average American will gain just more than a pound.

One pound, you say? Big deal! Well actually, it is a big deal. Because most Americans fail to lose the small amount of weight gained each year during the holidays, the weight gain becomes quite significant over time, according to a study conducted by the National Institute of Child Health and Human Development and the National Institute of Diabetes and Digestive and Kidney Diseases.

This study made me wonder. Physical therapy is a treatment method that focuses on pain relief, healing, restoring function and movement and improving body mechanics as well as improving a patient's overall fitness and wellness. On top of ignoring the general rules of health during the holidays, do Americans who require physical therapy neglect that aspect of their health as well? How can you-as PTs and PTAs-help your patients meet their fitness goals or maintain the ones already achieved? Do you feel particularly burdened during this hectic time of year? Are patients continuing to be compliant during the holiday season?

A recent article on CNN suggested that the American obesity epidemic and global warming may have more in common than you'd think. According to the article, "public health experts suggest people can attack them both by cutting calories and carbon dioxide at the same time."

How do you do it? Easy. Walk or bike instead of drive.

One scientist estimated that if all Americans between 10 and 74 walked a half hour a day instead of driving, they'd cut annual U.S. carbon dioxide emissions by 64 million tons, save 6.5 billion gallons of gasoline and shed more than 3 billion pounds overall. 

Both the Centers for Disease Control and Prevention and the American Public Health Association plan on promoting the dual benefits of combating global warming and obesity through exercise.

Although the benefits are great, changing habits is hard to do. Many people won't willingly walk or bike to the store instead of drive.

Do you think linking obesity and global warming is a creative way to get people moving?

The APTA's annual Preview 2020 conference will take place this year from Nov. 16-18 in Phoenix, AZ. According to the APTA's Vision Statement for Physical Therapy 2020:

"Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention and wellness services. Physical therapists will be practitioners of choice in patients'/clients' health networks and will hold all privileges of autonomous practice. Physical therapists may be assisted by physical therapist assistants who are educated and licensed to provide physical therapist-directed and supervised components of interventions."

What are your thoughts on current progress toward these goals and whether or not these goals should indeed be the focus of the profession?

Last week, the Los Angeles Dodgers made news by hiring Sue Falsone, MS, PT, ATC, CSCS, as the first female physical therapist in Major League Baseball. The hire highlighted the increasing trend of professional sports teams bringing in their own physical therapists.

In the past, injured athletes would be sent to independent physical therapy practices for rehabilitation. Teams would have unwritten agreements with certain providers to send players exclusively to that particularly facility for rehab, so some may see hiring a team PT as simply the next logical step.

From a professional standpoint, this can only be seen as a positive. Each sector of society that accepts and embraces physical therapy as an essential part of its organization is another important step towards professional autonomy. The fact that athletes comprise such a large portion of rehab patients makes this particular victory all the more vital, while the hiring of a female therapist emphasizes the importance of equality in the workplace and the availability of these jobs to all rehab professionals, regardless of gender.

What are some other areas of society that could benefit from the inclusion of physical therapy?

The notion is not a paranoid one; despite the best intentions of therapists to educate and even of many personal trainers to represent themselves accurately, patients and clients who seek expertise on strength training and exercise for therapy can become genuinely confused when considering who to ask as an expert in this area.

The American Physical Therapy Association takes a proactive stand on lobbying for decisions in state PT practice acts-and the practice acts of many other professions-to fight infringement cases that endanger PTs.

There are many documented cases of possible encroachment on the PT profession, most notably in legal decisions on the advertising methods and practice acts of chiropractors, exercise physiologists and athletic trainers. These professions are, arguably, somewhat similar in educational requirements and training, albeit not nearly as comprehensive as that of physical therapists. But the same cannot be said for personal trainers. Most of those programs require a much smaller amount of education to earn certification to begin legitimate practice in that field.

Have you had an experience with fighting encroachment between personal trainers who bill themselves as "PTs"? Do you feel this issue presents a looming problem for the profession?

PTs typically possess strong interpersonal skills used to educate patients about treatment options. They tend to be compassionate and possess a desire to help patients and interact positively with patients' families. Furthermore, many physical therapists are expected to continue professional development by participating in continuing education courses and workshops.

But many PTs find that they do not naturally possess managerial skills so the transition from clinician to manager can be somewhat stressful. So how do PTs brush up on or even acquire managerial skills in the first place?

At the fair, therapists promoted the capacity for movement, evaluated the best exercises for each individual and offered tips on starting a fitness routine. Visitors were encouraged to stop by the fair to meet the staff and find out how they could improve their fitness level.

"Even small amounts of physical activity can help improve fitness and health in children and adults. Unfortunately, with busy schedules and higher demands being made on both parents and children, incorporating fitness in a family's schedule can be a challenge," Patricia Repici, chief physical therapist of the county's outpatient physical therapy division, said in a press release.

Yes, physical therapists support the US Surgeon General's physical activity recommendation (children should get 60 minutes of moderate physical activity and adults should get 30 minutes of moderate physical activity most days of the week). But do you think PTs and PTAs should actively encourage patients to exercise outside the realm of rehab? Or do you think decisions on activity should be left to the patients themselves?

Did you do anything like the Cape May County Department of Health to celebrate National Physical Therapy Month?